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Goa In Search Of New Health Insurance Model

THE Goa government has been running the Deen Dayal Sawasthya Seva Yojana (DDSSY) on its own since the refusal of the United India Insurance Company, which was awarded the contract to implement the scheme, to accept the health department terms. The scheme was launched in September 2016. The term of United India Insurance ended one year after the launch and the government failed to find a new successor. The term of United Insurance was extended three times thereafter, the last extension ending on May 31, 2018. The government had to step in as hospitals empanelled under the scheme refused to treat Goan patients citing uncertainty about payment of their bills. The scheme is now being administered by a third party administrator that clears the claims raised by the hospitals. Though a tendering process was started some months ago to select a new agency, it has made no headway as the insurance companies which participated in the procedure have quoted amounts which are much higher than the government expected.

The health department has announced that it is going to send a team to study the Gujarat model of health insurance, even as it examines some key features of Modicare to incorporate in the state scheme. Before adopting the Gujarat model, the state government must arrive at a sound judgement about the applicability of the model to Goa. Health Minister Vishwajit Rane has said that the state government had decided to study the Gujarat model because it was a ‘hybrid’ scheme, under which a part of the payment to hospitals is made through insurance and the rest through trusts. It is not clear what is meant by ‘rest of the payment through trusts.’ If trusts are supposed to contribute to the scheme, which trusts the Goa government would empanel to pay for the medical insurance, and on what basis? All care has to be taken to ensure that the scheme is not made cumbersome with the introduction of new entities in its implementation and patients in urgent need of treatment for serious diseases do not suffer. The average Goan would expect the health department not to introduce new ambiguities in the process of removing the old ones.

As far as our knowledge of the Gujarat health insurance model goes, first of all it is not meant for most Gujaratis, unlike the scheme in Goa. The Gujarat scheme, known as the Mukhyamantri Amrutam Yojana (MAY), covers only 38 lakh below poverty line (BPL) families, assuring them free treatment for critical diseases. Gujarat provides a health insurance cover of up to Rs 2 lakh per family to the economically weaker sections (EWS) and also bears part of the transportation cost of upto Rs 3,000 per annum. The Mukhyamantri Amrutam Yojana covers surgeries for cardiovascular diseases, neurosurgery, burns, polytrauma, cancer, renal and neo-natal diseases. The Gujarat government has empanelled public, private and trust hospitals for conducting surgeries under MAY. The mention of ‘trust’ in MAY is about treatment in hospitals run by trusts and not about part payment being made by trusts. The health department needs to clarify to the Goan people what kind of trusts are going to be involved in the DDSSY scheme if the Gujarat model is adopted: trusts that run hospitals or trusts that exist for philanthropy?

The Gujarat government has health support schemes other than MAY, such as Janani Suraksha Yojana, Bal Sakha Yojana and Rogi Kalyan Samiti, which are also largely aimed at helping people classified as BPL, Scheduled Castes, Tribes or EWS. As Gujarat’s health support schemes are for BPL, SC/ST and EWS families, will they hold good for Goa, given its limited number of BPL families? The DDSSY is a well-designed scheme and covers a large section of the state’s population. Of course, we shall wait to see what the health department’s team learns from the Gujarat health insurance model and what it finds worth implementing in Goa. However, the state government will have to give a deep thought on the way forward as any scheme to provide health cover only to a certain section of population could invite backlash from those left out. Rather than making such changes, the government should apply the Centre’s Modicare scheme – known as the Ayushman Bharat Swasthya Bima Yojana which the central government claims to be better than Obamacare and expected to be launched on August 15 – to the BPL families and see that as many people are covered under it as possible. Such adaptation will remove them from the ambit of DDSSY and bring down the premium to be paid to the insurance companies.

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